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Synchronized Cardioversion:
Synchronized cardioversion is a LOW ENERGY shock that uses a sensor to deliver electricity that is synchronized with the peak of R-wave.
Synchronization avoids the delivery of LOW ENERGY shock during cardiac repolarization (T-wave). If the shock occurs on T-wave, there is a high likelihood that the shock can precipitate Ventricular Fibrillation.
The most common indications for synchronized cardioversion are unstable tachyarrhythmias with palpable pulse.
Step 1. Prepare the patient.
Sedate conscious patients unless they are unstable or rapidly deteriorating.
Ensure that airway equipment and oxygen devices are within arm’s reach.
Step 2. Prepare the defibrillator.
Turn on the defibrillator.
Attach the monitor leads to the patient.
Ensure that the patient’s rhythm is displayed properly.
Position the conductor pads on the patient in an anterior-lateral or anterior-posterior position.
Step 3. Activate the synchronization mode.
Engage the synchronization mode by pressing the sync control button.
Look for markers on the R wave which indicate the sync mode.
Adjust the monitor, if necessary, until the sync markers occur with each R wave.
Synchronization allows the shock to be provided safely away from the T wave, avoiding the R-on-T phenomenon.
Step 4. Select energy level.
The recommended energy levels used to perform synchronized cardioversion vary from 50 to 200 joules.
Choose the appropriate energy level according to ACLS guidelines.
Step 5. Shock the patient.
Make an announcement to the team members that you’re charging the defibrillator and shout out "clear" for everyone to stand clear.
Press the charge button.
Make sure the patient is clear once more after the defibrillator is charged.
Press the shock button.
Step 6. Repeat the shock with increased energy.
Check the monitor and vital signs.
If tachycardia persists, increase energy level according to ACLS guidelines.
Press the sync button again to activate sync mode before charging.
Note that many defibrillators will default back to unsynchronized mode after a synchronized shock; this default allows for an immediate defibrillation if your cardioversion efforts produce Ventricular Fibrillation in the patient.